Patients and MethodsBetween March 1987 and March 1997, 20 modified Thompson quadricepsplasties were performed by one of the authors (SBH). The mean age of the patients was 37 years (18 to 64). There were 18 men and two women. In 17, the procedure followed a fracture of the femur. Of the remaining three, two had achondroplasia and stiffness resulting from femoral lengthening by the Ilizarov method, and one had suffered poliomyelitis. The mean interval between the initial operation and quadricepsplasty was 28 months (14 to 60). The mean flexion contracture was 7.0° (0 to 30) with active flexion to 50.0° (5 to 80). The mean range of movement was thus 43.0° (5 to 80). The mean follow-up was 35 months (24 to 52). The range of movement of the knee was measured at each visit by the surgeon who had performed the operation (SBH) using a goniometer with 30 cm movable arms and a scale marked in 1° increments. The stationary arm of the goniometer was placed parallel to the long axis of the femur along a line extending from the greater trochanter to the lateral condyle, and the movable arm was placed parallel to the long axis of the fibula, between the head of the fibula and the lateral malleolus.The final results were assessed by Judet's criteria: 8 excellent, if flexion was greater than 100°; good, from 81° to 100°; fair, from 50° to 80°; and poor, if less than 50°. Operative technique. Medial and lateral parapatellar incisions were used for arthrolysis (Fig. 1a). The knee was then flexed and if inadequate flexion was obtained, an anterolateral or lateral incision in the distal two-thirds of the thigh was performed to release adhesions around the quadriceps muscle (Fig. 1a). The tensor fascia lata was divided transversely in the distal thigh. Vastus lateralis was isolated from rectus femoris and released close to its patellar insertion (Fig. 1b). Vastus medialis was released from rectus femoris by stripping with a finger (Fig. 1b). Rectus femoris was freed from vastus intermedius and from the anterior surface of the femur and upper pole of the patella (Fig. 2a). In four cases in which a satisfactory range of flexion had not been achieved at this stage, Z-plasty of rectus femoris was performed to lengthen the tendon (Fig. 2b). The procedures were carried out using a tourniquet, and the wound was closed over suction drainage. The tourniquet was released, and the appearance of the skin flap was checked, while the

No abstract

Between 1987 and 2006 we performed a modified Thompson's quadricepsplasty on 40 fracture-related stiff knees and followed the patients for a mean of 7.9 years (2 to 11.1). The factors affecting the final gain of movement were investigated. A total of 15 knees required lengthening of the rectus femoris. The mean flexion gain was 70.2° (42.3° to 112.5°). According to Judet's criteria, the results were excellent in 30 knees, good in seven, and fair in three. The range of movement which was achieved intra-operatively was related to the gain of knee flexion on univariate analysis. Five patients had complications: deep infection in one, recurrent patellar dislocation in one, and rupture of the extensor mechanism in three. This modified technique gives satisfactory results. Achieving maximum knee flexion intraoperatively seems to be the most important factor in enhancing the outcome in patients with stiffness of the knee following fracture.